Posted
by
Soulskill
on Sunday February 24, 2008 @11:08AM
from the no-not-literally dept.

biobricks writes "The New York Times is reporting that people who could benefit from genetic testing are too afraid their health insurance companies are going to raise their rates or deny them coverage to find out the health information contained in their own genes. There is a growing "genetic underground" where people pay for their own tests so they won't have to share the results with insurers, and beg doctors not to divulge their genetic status in medical records. A bill that would ban genetic discrimination by insurers and employers — and presumably make people feel safer about taking care of their health — is stalled in the Senate. We've discussed these types of personal DNA tests in the past."

is always to avoid paying out money and to aggregate money to build profit.

An insurance is a way for the insured to get an acceptable cover for risks and an insurance company also has to take a reasonable risk. Even if a certain genetic predisposition exists doesn't mean that it actually is triggered in an individual.

Isn't this just another sign that the adoption of new technology (e.g. broadband) by the American public is slowing due to governmental and societal hassles? You don't have to be a wacko like Michael Moore in Sicko [amazon.com] to admire the benefits of a public health system. If people can't lose their coverage, people might not fear DNA testing.

The interesting thing is that if the US had a health care system based more around prevention rather than treatment (and that includes insurance companies as well), costs would probably be lower since it's often cheaper to 'treat' illness factors before they become a full disease. In the case of DNA testing, if it revealed I had a predisposition for a certain disease it's stupid for insurance companies to "punish" me for finding this out since I may be able to prevent it from ever becoming a really expensive problem, thus saving them money.

The interesting thing is that if the US had a health care system based more around prevention rather than treatment (and that includes insurance companies as well), costs would probably be lower since it's often cheaper to 'treat' illness factors before they become a full disease. In the case of DNA testing, if it revealed I had a predisposition for a certain disease it's stupid for insurance companies to "punish" me for finding this out since I may be able to prevent it from ever becoming a really expensive problem, thus saving them money.

Nonetheless, isn't there some kind of an economic argument that if insurance companies paid for people to avoid one big illness, with their longer lifespan they would end up costing the company more in smaller illnesses over time?

Nonetheless, isn't there some kind of an economic argument that if insurance companies paid for people to avoid one big illness, with their longer lifespan they would end up costing the company more in smaller illnesses over time?

Plus, the quicker someone dies, the less chance they have of getting one of those expensive dieseases...

Its like social security - a REAL patriot will die on their 65th birthday!

Its like social security - a REAL patriot will die on their 65th birthday!

It might (or not) be helpful to remember that when Social Security began, average life expectancy was slightly under 65. so fewer than half those who paid into it collected, and most of those who did collect died shortly after they began collecting.

Social Security's financial woes are entirely a result of the increasing life expectancy of Americans....

Its like social security - a REAL patriot will die on their 65th birthday!

It might (or not) be helpful to remember that when Social Security began, average life expectancy was slightly under 65. so fewer than half those who paid into it collected, and most of those who did collect died shortly after they began collecting.

Social Security's financial woes are entirely a result of the increasing life expectancy of Americans....

Don't worry, we're working around the clock to correct this problem.

Also, you're oversimplifying life expectancy. I believe the life expectancy you're referencing was that of a newborn child. If a person manages to survive childhood, their life expectancy goes up. If they manage to survive to adulthood, their life expectancy goes up again. If a person manages to survive everything from adulthood to retirement, their life expectancy is even higher. I can't find the exact numbers right now, but although

"Nonetheless, isn't there some kind of an economic argument that if insurance companies paid for people to avoid one big illness, with their longer lifespan they would end up costing the company more in smaller illnesses over time?"

If your insurance premium was per-life rather than per-year, then yes it might...

Consider that the National Association for the Self-Employed offers the following on their policies: you pay a monthly premium from now until you're 65. Your premium never goes up. When you get there, they say, ok, lets look at your claims against the insurance. They add them up. Then add up the premiums you've paid. And they give you the difference if anything is left over.
Apparently, they invest the money because i was told that if I started today, i would have about $800k in premiums paid. Then they would deduct the claims and give me the difference.
They are the first company I've heard of that does this. Had I know about this, I would have done it a long time ago.

...is a front for MEGA Life and Health [businessweek.com]. Though they certainly try to hide it, NASE is not an actual indepentent "association", but the marketing arm of MEGA. Fortunately, the high-pressure sale techniques of the agent I encountered were enough to tip me off that something was wrong, and I Googled before I bought and so learned how bad the "coverage" MEGA provides actually is [boston.com].

I would like to point out that I think there should be at least some reward for people who take good care of themselves.

I like the idea of a Health Savings Account in conjunction with a High-Deductible Health Plan [opm.gov]. The idea is that you contribute a limited amount annually to a special IRA. Each year, you pay (tax-free) for your medical care out of that IRA until you hit your deductible. Then, everything's free. Next year, you contribute the same limited amount, the deductible resets, wash-rinse-repeat.

The neat thing is that you benefit from leading a healthy lifestyle, but you're still covered in case of some catastrophic health issue.

One secondary effect of using an HSA is that it makes routine healthcare decisions economic decisions. I think that's a good thing. Others might not agree. But I suspect that if everyone used these things, the cost of healthcare would decrease. Just my opinion.

Sort of like a nationally-applied, universally available fund from which to pay for healthcare? Really?

No, actually, not at all. A Health Savings Account is an individually-owned savings account. Anyone who wants to do health insurance this way has to have their own, and provide all the money that goes into it. The catastrophic insurance is provided by private insurance companies, much like car insurance.

Not at all like the NHS, the Canadian system, the French communal insurance system etc..etc.. at all...

Correct. It's not at all like any of those things. In fact, I'm actually very relieved that it's nothing like the NHS [typepad.com]. I prefer my healthcare *not* to kill me...

See, it all sounds good until you call it 'socialised medicine'

No, I think an HSA is probably as close as you can get to the polar opposite of Socialized Medicine.

In reality, you know it's better than the status quo, you just can't bring yourselves to admit it.

... Well, I believe that HSAs are a better way to provide health insurance than our current third-party payer system, and a *much* better way than Socialized Medicine. HSAs provide an incentive for healthy living, and for making economic decisions about your health, and about obtaining healthcare. The current way we do things in the US, and the national systems of health insurance in other countries provides exactly the opposite. I mean, don't get me wrong - "Free" healthcare sounds like a fair, nice, wonderful idea. But like anything else that's free, you find that you run out of it rather quickly.

if the investments lose money, you have no health care - they still get their cut

at age 65, we wash our hands of you, after taking our cut, so forget about all those expensive health problems old people have

its not insurance - if we lose money on you, we don't average it with other people in a collective risk pool - but we still get our cut

the premium never goes up - but medical expenses are increasing by 12% a year, doubling every 6 years. In 30 years, that $800k will buy $25k worth of health care in today's dollars. That will keep you in Depends in a nursing home for what, one year today?

The statistic I heard (regrettably I can't find/am too lazy to try and source it now) was that in Canada, of every dollar spend on health 8 cents is administrative costs.

Versus 24 cents of every dollar in the US. And we have better overall healthcare outcomes. (Although to be fair, the US has some pockets of spectacular poverty without an equivalent in Canada, except for Vancouver's DTES, so the health care outcomes comparison is probably apples and oranges.)

So why not just, y'know, by an act of congress, make the government the single-payer for anybody who wants it? We basically did the same thing in the 60's when we brought in medicare, the doctors actually went on strike to try and prevent it, but it's a genuine Good Thing to have.

That is the often-repeated mantra. However, it is, at best, simplistic and at worst very misleading. There is a very nice summary of some findings in this week's New England Journal of Medicine, very accessible reading for the non-M.D. too. Take a look if you are interested, it is free access for all:http://content.nejm.org/cgi/content/full/358/7/661 [nejm.org]

Before the idiot flamers start -- I am NOT saying that the above poster is absolutely WRONG, just that it is more complex as some of the followup posts sugge

"In the case of DNA testing, if it revealed I had a predisposition for a certain disease it's stupid for insurance companies to "punish" me for finding this out since I may be able to prevent it from ever becoming a really expensive problem, thus saving them money."

But, that's exactly what they do and want to do...especially if you are trying to get insurance privately!! If you have a pre-existing condition as innocuous as athlete's foot....I've hear of people being turned down. I went indie...and before I got insurance, I let my other lapse and waited too long for cobra...and had a HELL of a time getting anyone to take me at any price due to high triglycerides.

I finally did by getting with a fly by night place...and then using that as reference to get with a real insurance co...but, these days I gotta tell you, I pay for most all tests I can on my own, and I try to get my Dr. to write down as little as possible when I have a complaint so as not to put anything in a permanent record about my health.

I still can't get long term disability...dues to some complaints about chest pains which turned out to be nothing at all.....that is on record.

I can easily afford whatever premiums they would charge, but, I can't get them to even offer me coverage.

It isn't so much that health care is too $$ or coverage is....it is that insurance companies can cherry pick who they want to cover. All I want is catastrophic coverage...and I can save the rest I want in an HSA that rolls over, and can be invested in the mkt..and grows...pre-tax. But, I just find it is hard to get coverage at all if you even appear to be a risk...

it's stupid for insurance companies to "punish" me for finding this out

Um, yeah, assuming that insurance companies are playing straight. But they're not. There's a million poeople in the US employed full-time to do essentially nothing but find ways to deny the insurance claims of people who have been paying health insurance premiums for years.

Compared to up here in Canada, you guys pay lower taxes, but I'm not ever going to be charged one cent for a medically necessary treatment. (granted we still have some catching up to do with europe on drug coverage...)

So, you can pay X% in taxes and have free medical. Or you can pay some fraction of X in taxes and make up the difference in health insurance, which may or may not cover you when you actually need it when you get cancer or something.

Who was that greek stoic who said "Call no man happy, until he is dead"? It's like that with insurance. Call no man insured, until he is dead.

It is cheaper to hire a bunch of lawyers instead...I wonder sometimes why such vital part of our society is used mostly for profiteering. There was an article in the economist few weeks back: they compared the avoidable deaths due to problems in health care system and costs of the system in various developed countries. The result was interesting: US was in vary bad shape - the highest investment and poorest record. One may ask why but I think the answer is rather obvious - no control and focus on profit mak

They also _delay_ payouts (in addition to not paying out for ethically _bogus_ reasons - you did stuff 10 years ago so we're not paying, don't like it? Don't think that's relate? Sue us - have fun attending court while you're dying)

Say a company makes millions of dollars worth of payouts a day, if they delay for 2 months, they make a LOT of money.

Doctors paid by the insurance companies usually have an incentive to work for the insurance company rather than the patient. So more people die that way.

Sometimes it's cheaper if the person dies - sure you pay out eventually, but I think you pay out less. They'll do the math accordingly.

I guess the idea is if some people have to die so that you can afford another yacht/plane/mansion, too bad for them.

was that the results are mailed ONLY to the test subject. The paper the patient gave me with the lab address to mail to specifically stated that they will not release the results to anybody else, not even the doctor unless there is a signed document declaring that this is the patients decision. Granted this is only one lab, but Im hoping its the same for all labs.

I think this is pretty interesting, because 100% of the time, I have to fight to get a solid copy of lab reports on blood work, and half the time the staff at the doctor's office (across several offices) will look at me like I'm some kind of freak because I want copies of my own medical tests and doctor's notes. I can ask that copies of whatever's produced by a test be sent to my home address as well as the ordering doctor's office and they never, ever come. Not once.

The only effective way I've found to actually get records is to tell them I want records faxed to another doctor... at a number I receive at.

If my experience is any indication, most patients don't have *access* to their own medical records, let alone control over them.

I am a Canadian citizen, that's why I have to go to other countries to get the kind of attention that I want to my health. I like Germany for this, a couple of thousand of Euros give me a lot of power in terms of diagnostics. There is NEVER a question about me getting full access and control about what is happening to me. All tests are in my hands, all choices are for me to make with the advice of really good doctors. That's the way I like it.

IAAP (I am a physician), and I can tell you that I *never* hesitate in giving patients their lab results, etc. I will even give them a copy of recent tests, etc. I only make a not of it in the official chart if the patient asks for copies of their entire record (but even then don't delay). Physicians are part of the service industry. If we don't serve, there are plenty of alternatives.

That being said, I've seen other medical offices in which their general policy is to avoid giving official documents to patients, in fear of litigation. My thought on the subject: A happy patient is less likely to sue, even if a mistake is made.

Quite seriuosly, this is one reason why I wouldn't want to live in the USA: From what I hear about that country, pretty much every single decision is made based on whether someone can sue one over it - because sooner or later someone will.

It's probably not that extreme, but I do think it reflects on US American society that it has an image of being rabidly litigious. No troll intended, but if I lived there the constant fear of someone suing me over trivial nonsense would severely impact my quality of life.

The only effective way I've found to actually get records is to tell them I want records faxed to another doctor... at a number I receive at.
I am actually noting this trick for future use -- do you ever have to give an explanation of why you have another doctor / who it is? And if so, what's your excuse?

I'm not sure where you work(ed?) but this is the exact opposite of my lab in California, which is part of a major national chain. The report goes to the ordering physician, and a copy to the patient only if the ordering physician authorizes it. Except for certain low-complexity tests, all lab testing has to be ordered by a licensed physician or an AP/NP under their direct supervision. This is regulated by the state Department of Health Services.The problem discussed in the article has been a problem for

People already do this with tests other than genetic ones. I have heard many times: "Don't write this in my record but..." with regard to 'stealth' health care problems. In most states you can order labs without a doctor's prescription through direct to consumer labs, so you can find out all sorts of things that can effect your insurability. Heck, go to a pharmacy and you can check your BP for free.

The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single payer, but lets be honest, the US is far too much a classist society to adopt that... sigh.) Though what's particularly stupid about such a bill is that it would outlaw discrimination from insurers if I noted in your record that you had a blood test that said you were predisposed to diabetes or hypertension, but it would not outlaw the same discrimination that would occur if I noted in your chart that your BP was 160/100 or your fasting blood sugar was 160. If we diagnose your hypertension or diabetes with a $2000 test, you are safe, but if I diagnose it with a $3 lab test or by taking your BP several times, you are hosed.

Unfortunately this wont help for tests where there are already established easily detected stuff... What it will help prevent discrimination for is genetic defects and genetic disorders that are difficult or impossible to diagnose without genetic tests like Huntington's Disease (there was a slashdot article about some young woman doing a test in her 20's to tell how much 'time' she had before the disease affected her) and other such things where the only way to tell is a DNA test.Just like you're screwed wi

The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single payer, but lets be honest, the US is far too much a classist society to adopt that... sigh.)

You're missing the bigger picture.

Ask people if auto insurers should be able to raise rates for people who cause an accident, most will say yes. Ask people if auto insurers should be able to raise rates for people whose cars are hit while they're parked, most will say no. Ask people if health insurers should be able to raise rates on smokers, most will say yes. Ask people if health insurers should be able to raise rates for someone genetically predisposed for a disease, most will say no.

What people want isn't economic-driven health insurance, nor is it universal health insurance. What people want is a system where you have to pay more for negative influences under your control, but not pay more for negative influences outside of your control. This is why universal health insurance is a no-go in the US - people get hung up on the idea that folks who take unnecessary risks or don't take care of their bodies will be getting a "free ride". They don't care that someone who develops Alzheimers will be covered and raise their insurance rates; in fact they're altruistic enough that they'll gladly donate to charities to help people who develop diseases outside of their control. But they find repugnant the idea of them being forced to (via universal health care) help someone who won't even try to help himself.

That's the obstacle universal health care has to overcome to be accepted in the US. That's why people don't like the idea of genetic testing to determine health insurance rates, even though on an economic level it makes perfect sense. Figure out a way to incorporate this concept into universal health care and Americans will probably be all for it. If you can't find a way to do this, then you'll have to resort to statistical models of overall benefit (the no-fault vs. at-fault auto insurance debate - where determining liability costs more than the benefit of assigned risk), which is a much harder sell.

"The solution of course isn't congress passing a bill that makes such discrimination illegal, but rather to pass a bill that establishes universal health insurance (preferably single paye..."

I gotta say I disagree with you..I'd prefer the former. I'd much rather pay my own way, save in a HSA pre-tax....and pick and choose my own doctors....and while healthy, have my pre-tax medical dollars I save grow tax free.

My trouble has been just getting high deductible insurance or long term disability insurance 'c

*sigh* So now we have to hide information in the fear of the privately owned companies, who operate for profit and nothing else - as well they should; that's how the system works - increasing our rates. How bad are things going to have to get before we let our taxes take over where insurance companies currently operate? Yes yes, it's "taking away our freedoms." Y'know what, though? I'm willing to give up my right to die from a treatable wound or illness.

The problem is, they don't merely increase your rates. With the right (or wrong, as the case may be) set of pre-dispositions, an insurance agency will refuse to accept your business, as you are too much of a risk. This is less of an issue with employer group plans, of course, but it can still happen. Life insurance companies are even worse than health insurance companies.

You are taking a VERY individualist view of evolution. Humans are a social animal, we can all gain from contributions from even the weakest(physically) members of society. How many artists, inventors, scientists, mathematicians etc. have had physical abnormalities(maybe even sometimes genetic) but have nonetheless contributed to the advancement of our species?

Killing anyone who has a disability(or just leaving them to fend for themselves) probably does not bode well for the longevity of your culture. There have been groups in history that killed any young that had abnormalities, one of the most famous being the Spartans. You don't see their culture dominating the globe, do you?

Adaption happens at the level of individuals. When groups develop that protect their less adapted members, the group as a whole becomes less well adapted. It has nothing to do with qualitative judgments and is entirely objective.As to the rest of your comment, I'll just point out that the majority of charitable giving is done by those who think the government should stay out of it and those who give the least think the government should be involved. Anytime I hear someone telling me that the government need

"To use a real life example, does it make sense that the people in Nebraska should have to carry the insurance burden for the people who choose to live in hurricane alley?"

Well, if you're talking about LA (Louisiana to those that keep thinking I'm talking about a city in CA) you might want to do just that.

Fully aobut 1/3 of the energy for the US comes in through, is processed/refined in this area. Also, a lot of the seafood of the US comes from here. Not to mention that all those nice farmed products fro

I know it may sound heartless and uncivilized, but at what point is a person who is fundamentally broken down kicked off the public teat?

It not only sounds heartless and uncivilized, it actually is. Do you really want a society where there's legless people scrawling around on skateboards begging for food because they're "fundamentally broken down"? It wasn't that long ago we did, and I consider it progress that the developed world mostly doesn't have that anymore. Evolution has really nothing to do with it.To use a real life example, does it make sense that the people in Nebraska should have to carry the insurance burden for the people who choose to live in hurricane alley?

I don't really know. But at least you can choose to not live in "hurricane alley". I'm not sure what the big alternative is here for people who are "fundamentally broken". Death?

It not only sounds heartless and uncivilized, it actually is. Do you really want a society where there's legless people scrawling around on skateboards begging for food because they're "fundamentally broken down"? It wasn't that long ago we did, and I consider it progress that the developed world mostly doesn't have that anymore. Evolution has really nothing to do with it.

First, you didn't answer my question. Before I'm willing to agree to paying for the health care for everyone, I want to know at what poin

Evolution is not a religion. It is not a guide for the proper way to live. It does not provide any of the answers for deciding this problem.

Just because Mother Nature does something one way, does not mean that this is somehow the best, most proper, fairest, smartest, long-term safest way, or that it has any other advantage except for the short-term survival-of-the-fittest well-not-actually-you-but-at-least-your-genes kind.

Mother Nature is a bitch.

You can argue to what degree humans should care and provide for other humans in a society, but do not use evolution as an excuse.

Interesting perhaps, Insightful no. The evolution that you speak of involves economics as much as it does biology. Those at the economic apex of wealth get there through accidents of luck (e.g. born into wealth, gambling addict lucked-out on a lottery ticket, etc), gross illegal activity (e.g. bank robbers, mafia hit men), manipulation or dishonesty (sales people, CEOs, union-busters; like the asshats in the auto-industry hiring detectives to find any type of dirt on Ralph Nader when he lobbied for safety r

The evolution that you speak of involves economics as much as it does biology. Those at the economic apex of wealth get there through accidents of luck (e.g. born into wealth, gambling addict lucked-out on a lottery ticket, etc), gross illegal activity (e.g. bank robbers, mafia hit men), manipulation or dishonesty (sales people, CEOs, union-busters; like the asshats in the auto-industry hiring detectives to find any type of dirt on Ralph Nader when he lobbied for safety regulations for automobiles, or more

To use a real life example, does it make sense that the people in Nebraska should have to carry the insurance burden for the people who choose to live in hurricane alley? That's what Florida thinks should be the case.

It's only fair since Florida will carry the insurance burden for all the people in Nebraska that live in Tornado Alley. That's the very definition of insurance. Don't like it, don't buy it. And if your house burns down you can be proud that you didn't have someone else carry your insurance

A tornado can do what, couple million dollars of damage, tops?
A hurricane can do many billions of dollars of damage.
In fact, my homeowner's policy in Nebraska is incredibly cheap compared to what a similar one would be in Florida (even taking into account that my current house would cost 2x as much in Florida...)

You're conflating at least two meanings of "believe in". Believing that something happens doesn't imply assessing it as desirable.Additionally, most people who worry about life insurance are beyond the reproductive age, and as such evolution has little "concern" about their living or dying. (I.e., things that are only damaging after the reproductive years are at most mildly selected against by evolution, and can even be selected in favor of. There are suspicions that this may explain why Huntington's Dis

I think ultimately, my choice in who to vote for in the general election will be based largely on privacy issues. If there's any supreme court nominees to be had, I want them to have my privacy in mind in the future world of the internet and genetics.

If you're basing your decision of who to vote for on that, then you, sir, are dumber then I.I would prefer basing my decision of what structural changes a candidate would implement in order to deal with the reality and thus avoid a Gattaca scenario.

Getting the insurance companies out of health care is a very good place to start. (They are fundamentally dedicated to health-don't-care because caring about the fate of individuals would impact their bottom line.)

The movie Gattaca. Not the best movie out there, but definately not a horrible movie. It is about the future when people are discriminated against because of their genes. Looks like we are getting closer to the sci-fi world that we dreamt about 20 years ago...

That is what you get when health insurance companies are allowed to make money: they try to make money and do not care about the health of the people as long as they can not make money. In my opinion the health insurance companies should be rewarded for their service to people and peoples health, not for making money.

Of course, I am living in socialist Europe, so for me there is not really a problem. However, for you guys in the US, it kind a sucks, does it not? Would it hurt to transform your health and insurance system as to promote health for everyone instead health for those who can and are willing to pay? Of course, there will always be people not paying, living as unhealthy as possible (obesitas, alcohol, smoking, driving in cars, etc), but in the end would it not be nice to know that your health is save no matter what happens with you economically?

Of course, there will always be people not paying, living as unhealthy as possible (obesitas, alcohol, smoking, driving in cars, etc), but in the end would it not be nice to know that your health is save no matter what happens with you economically?

No. Because no one is subject to random economic events. Yes, people unexpectedly lose their jobs, but anyone who is well prepared won't be subject to significant risk because of that. They will have savings set aside and they understand that they will have the (

No. Because no one is subject to random economic events. Yes, people unexpectedly lose their jobs, but anyone who is well prepared won't be subject to significant risk because of that. They will have savings set aside and they understand that they will have the (federally mandated) option to continue their current coverage for up to 18 months if they chose to pay.

So, you are working hard at your job, have no consumer debt, own your home, and have $50,000 in savings (much better than most Americans, but lets go for a best case scenario.) Then you get diagnosed with cancer. So you start undergoing treatment, but because of the toll on your health, you have to quit your job. Your EMTALA mandated coverage is $700 a month for you, but you elect to pay it because otherwise you will be unable to receive your treatment. It will take $12,800 of your savings, but that is your first priority.

You begin living as frugally as you can, but the bills keep mounting. Your insurance has a $2,000 deductible per year, then you have to pay 10% of costs up to a maximum out of pocket of $6,000 per year. So the first several months, you pay out $6,000, but then the first of the year hits and you again have to pay $6,000 in the first few months of the next year. So your $50,000 in savings is now down to about $25,000 just with your out of pocket costs and paying 18 months of EMTALA coverage.

The chemo and radiation you receive gives you profound weakness and nausea/vomiting. Unfortunately the inexpensive antiemetics phenergan, compazine, and reglan all give you a severe dystonic reaction. So the only one you can take is zofran, which your insurer refuses to pay for because its non-formulary. You only use it for the worst days after your rounds of chemo and split pills when you can, but its the only thing that will help. Even ordered online at the cheapest Pharmacy you can find they cost $10 a pill. So you end up spending an extra $300 per month for medicine in addition to the $15 per month copay each for your other half a dozen medicines. So your out of pocket drug costs are $400 per month. That plus your bare minimum living expenses (food, utilities, tax on your house, travel to and from the hospital) are about $2000/month. So by the middle of the year, your savings have dwindled to almost nothing.

So you begin borrowing by taking a loan out on your home, this gets you through the end of the year and into the beginning of the next. Unfortunately, as a result of the treatments, you suffered a mild stroke and now have to walk with a walker. So you begin the laborious process of applying for disability. You are initially denied, and hire a lawyer who works on commission, but he tells you it will probably be a year or more before you get disability (and hence medi-medi coverage as well.)

I'm getting tired of writing this, and depressed because its all too common. Over half of people in the US in 2006 who filed for bankruptcy did so because of health care bills. Over half of those were employed and insured when they became ill. Don't fool yourself into believing that you can render yourself immune from this should you lose your health and hence your usefulness to a capitalist society. We discard 'useless people' like yesterdays newspaper. And the only reason it hasn't happened to you is you are still producing.

The US "health care" system astounds those of us living in other countries. How come people put up with this?

Americans are pathologically paranoid about anything to do with government. It's in their cultural genes. That's understandable because the US was founded in order to get away from autocratic, corrupt and tyrannical European governments in power at the time. But that's also why they are willing to put up with severe dysfunctionality caused by lack of proper government.

No, I was just told a story by someone who can't even take the time to lookup which laws are relevant to the situation. The story was no more reality than your average night of WWE.Here's some problems with his story:

- $6000 year maximum? Not at any job I've ever had. Think $1500 for deductibles and then you're done paying. Everything beyond that goes on the policy.- EMTALA is a subsection of COBRA and has nothing to do with continued coverage after termination. It has to do with refusing coverage and trans

Let's go over the alternative in a country which has your blessed "universal healthcare":
You suffer kidney failure. You can't afford private treatment. You're put on a wait-list because dialysis is expensive and in short supply. You're over 55. You don't make the cut off. Your socialist system has decided that a 55+ year old person is not worth the expenditure. Since you depended on the state to support you, you have no private recourse. You die.

Great. Show me that hypothetical western country that has 55 as a cut off for hemodialysis and you will have a point. I believe in the UK the cutoff is 80 now. Not sure what Canada's is, but I met a patient who was traveling recently and had arranged HD locally who was from Canada and was in his 70s, so I am assuming its at least 80.

Though funny you should use that as an example, because all HD patients in the US are covered if they have no other insurance by Medicare-Renal. So we already in the US pay

Would they lower rates due to a clean genetic test compared to the normal now?

How long before insurance companies proactively raise rates, but then offer a discount back to normal if you provide genetic test results?

Is the bill worded such that neither penalties nor bonuses can be given out due to a genetic screen?

How much different really is it from family history, just a more accurate measure?

Insurance is all about modeling the risks for an individual based on available medical data. In *theory*, if genetic screening can increase the accuracy, then people with clean genetic situations should get decreased rates from what they pay now, while those with the dispositions carry the burden of the risk. If all goes according to the hypothetical, neither way is particularly feels 'fair'. On one hand, your rates go up because you got stuck with some genetic predisposition for heart disease that you couldn't control, that may never manifest. On the other hand, someone with a genetic disposition that will never suffer a particular ailment, will have to pay for the risk of that ailment anyway.

Of course, the chances insurance companies would *lower* any rates is slim, just jack up rates with the excuse of apparently increased risk individuals without ever acknowledging the class of reduced risk individuals.

Insurance is all about modeling the risks for an individual based on available medical data.

No, Insurance PROFITS are all about modeling the risks. Insurance is actually about distributing unknown risk among a large number of people. If I had a time machine and could look into the future and see if I'd ever need insurance, the whole thing would become completely pointless, as I'd know exactly what was going to happen. If the insurance company had access to my "time machine test results", they'd either cancel my health insurance if I was going to get sick, or I'd just sock all that money away in a bank account if I wasn't.In *theory*, if genetic screening can increase the accuracy, then people with clean genetic situations should get decreased rates from what they pay now, while those with the dispositions carry the burden of the risk.

I think what people are really concerned about here is that certain individuals will just not be able to get health insurance. We don't really worry about that for car insurance, or flood insurance, or whatever, since you can always choose to not drive, or live somewhere else. Without health insurance, the only real alternative if you get gravely ill is death, or bankruptcy and losing your job (then maybe medicaid will take over). I think most people would say those aren't very good alternatives.

No, Insurance PROFITS are all about modeling the risks. Insurance is actually about distributing unknown risk among a large number of people

You're right, taking my view of it to the ultimate extreme (knowing perfectly the future) reduces things to no insurance in the end. Of course, by definition, genetic screening is reducing the amount of distributed unknown risk, so it still would play into your more accurate description If all risks are known, insurance would devolve to meaningless either way. The opposite end, where everyone gets a flat fee won't work in today's market. Any company that offers a flat fee based on the total average of

"There is no way an HMO can properly function bound by such a rule," said PhysCare-Plus member-accounts departmental supervisor Toby Francis. "HMOs must be free to disclose patients' medical, personal, and financial information to insurers. How else can we determine what treatments a patient is or isn't eligible to receive? If someone needs a new lung and they don't have the necessary funds to pay for it, how are we supposed to know not to perform the surgery? I can't tell you how many cost overruns have be

That's a very interesting statement. I would have said that the *theory* of insurance is that it is a mechanism to pool risk, not merely to calculate it. Payments are based on prior probabilities, allowing us to plan our lives, and payouts are made to compensate for surprises. After all, if it doesn't do this, why have insurance at all? You minimise your premiums by cancelling your policy, so on the libertarian analysis the best insurance is no insurance; you just gamble on remaining as lucky as you are tod

From a health insurer's perspective you'd be foolish to cover a disease for an individual if they have the bad gene. This isn't discrimination. It's facts and statistics, common sense from a business perspective. Arguably they could charge higher rates to those individuals (like they do to smokers). Health insurers already "discriminates" against you if you've prior disease. They can continue to do the same and it will be no more wrong than it is now.
Discrimination is unjust. Medical facts are not discrimination.

They can continue to do the same and it will be no more wrong than it is now.

But it is wrong now. The entire US healthcare risk underwriting system is wrong.

By having thousands of individual risk pool managers obsess over saving money by kicking out people who might actually use healthcare services, we ironically end up with a system that costs us almost twice as much overall as any other country, while at the same time not even covering a huge swath of the population.

Meanwhile, needlessly stupid thing like worrying about who gets a hold of medical tests causes stress for millions. Millions more are tied to their corporate jobs like feudal serfs because of fear of losing healthcare benefits.

To stop this insanity, there needs to be one single uniform national risk pool.

Medical fact is not discrimination. Making a different decision based on differences in those medical facts IS discrimination. The person saying "we will not give insurance to this person due to this criteria" is discriminating. Wether that kind of discrimination is or not wrong is another matter. I personally think it is.

One thing is to make a person who decides to smoke pay more, as it is a conscious decision of that person, and that person could give up smoking to avoid higher fees, and another is to somehow marginalize you because of a gene, something that you cant change, and that you didnt choose.

The problem is the genetic tests available don't always give facts. The presense of a gene does not by itself indicate higher risk for most diseases, what it indicates, is a predisposition, so that if dozens of other factors are just so, combined with the gene, then your risk is higher. It is VERY subjective. Additionally, as someone else pointed out, genes are not something you can change. To make it more plain: We know that blacks are statistically more like to get certain diseases, therefore are higher r

You have made a perfect argument for why health insurance in a community should not be the equivalent of gambling.The argument that insurance companies already discriminate against people is exactly why this system needs to change. If a private system is not able to bear the burden of risk associated with provide all people the same coverage, it is a broken system. Sure, you and they will want to complain about how unfair that is and I will continue to tell you that this should not be about fairness. Insure

Don't sweat the small stuff, people. At the moment, the insurance companies can't accurately enough
correlate your DNA to your future expected healthcare costs - Your familial history and general current
health indicates that far more accurately.

So don't worry about taking your curiosity underground, the evil bastards simply don't care yet; and
when they do, you'll simply get your test date in the mail (or the option to drop your coverage).

without a Constitutional ammendment guaranteeing our right to privacy.And it's not just on the level of DNA testing. We're already hearing about the dangers that data-mining companies like Acxiom are posing to privacy through their purchase and aggregation of previously unrelated databases.

Universal healthcare in the United States would fix one part of the problem, which is that you could be denied insurance coverage based on factors over which you manifestly have absolutely no control.

Wait until someone's genome is copied without their permission from when they donate blood, and the privacy backlash leaves blood banks dry, patients dying.

Individuals should get the same explicit copyright protection on our personal data, including our genetic and other health data, as corporations get on recorded products. Personal data must be destroyed once the transaction for which it was initially transmitted is complete, with short timeouts, unless explicitly permitted into some specified other scope. Violations should be criminal violations of our privacy rights.

Probably we need a Constitutional Privacy Amendment to make indisputable the force and clarity of this protection of our rights. The Fourth Amendment already protects our private data, but the government hasn't been enforcing it. Since the 4th is itself redundant to the Constitution's lack of a created power to invade our privacy, it's clear that the fundamental line between private and public that is the basis of our liberty must be reiterated strongly or be ignored.

As our entire world becomes defined by the Info Age, the people better get our government to properly protect our privacy soon, or there will be blood.

The dangers of discloser of your DNA to potential insurers and employers would seem to create an opportunity for people to self-test.At the moment for a fee you can send a swab to a lab, and they'll return the results to you. That's reasonably private until Acxiom buys a copy of their database or the Department of Homeland Security decides it wants to know your genetic code for whatever reason.

But if you had an affordable device you could drop a swab into and have it return results, there would be no need f

They are in the business of evaluating risk and spreading that risk to all of their share holders while charging a premium based on the risk in order to MAKE A PROFIT.

You, as an individual, don't matter. In fact you, as an individual, don't exist.

If you fall into the cost side of the equation, they will try to eliminate you as you are reducing their profits.

You can't run health care for profit.

The United States is the LAST hold out in the civilized world where people think it can be. (Actually, they DON'T but the major shareholders, being anonymous pools of capital, DON'T CARE about the suffering of individuals.)

You aren't even a line item on a spreadsheet somewhere.

The only way to actually run a health care system (as opposed to the health-don't-care system currently in place) is with socialized medicine, just like we have a socialized military (you don't want a bunch of militias running around after all.)

Health is a social responsibility.

Insurance is an actuarial game played for profit. (As long as you don't need it, you don't mind losing a little bit since it is spreading risk around to all the players. The problem comes when you DO need it and the companies DON'T WANNA PAY. [With health care, you might very well DIE!!])

What we call health insurance in this country is actually a pre-paid health maintenance agreement. There is an insurance component, but by and large the costs are associated with routine care, not insured healt disasters. Right now, the closest thing we have is the high deductable health plans which work with a health savings account. In the HDHP, you pay every dollar of care out of pocket until you reach your deductable - about $2.5k for a single, or about 5-6k for a family. This excludes just about all routine care, which means that it doesn't kick in until you've hit a real stumbling block, healthwise. In return, the gov't lets you put away money, pre-tax, into an account (savings or investment) which you draw on to pay your health expenses.

Everyone on insurance already has a "single payer system," it's just that the "single payer" is the group of health insurance companies instead of the government, but they act and think with close to one voice. Right now we aren't covering everyone, though we could for about 1.2T/yr through the existing private system*. It would be a significant burden if the cost were borne by employers, as most businesses just can't foot the bill for $8-12k/yr/employee, especially when the coverage could cost more than the employee's salary.

Anyway, the point is that there may be two systems needed - one for health maintenance, and one for catastrophic coverage (which I like to call "hit-by-a-bus" coverage). As with all things, there are some gray lines at the boarder between the two. And this doesn't really address the DNA problem, though it would be reasonable to expect a test to get a rate for the catastrophic coverage, since that is a pretty straight forward way to more accurately determine risk, and no different than charging 22 year old males with sportscars more for auto insurance - even if the never drive more than 35 mph, and only take trips to church on Sundays. That's what probability and risk determination is about. If you don't like it, save your money yourself for that rainy day.

I will say that I would prefer cancellable "term" policies rather than the annual individual policies that are common today. Right now, if you're too expensive, you can simply not be renewed. With a term (say, 30 year) policy, you have a guarantee of coverage for your term with embedded annual escalation and whatnot, just like life insurance. You might even get a product similar to whole life insurance, which guarntees your coverage until you die. (Note: just like life insurance, health insurance has caps on your benefits).

As with all other things, there ain't no such thing as a free lunch, so the total money into the system = total money out of the system. There profit on gross in healthcare insurance is probably small, just like most businesses (2-8%). My point is that everyone can't just put in their $120/week, get routine healthcare (office visits, minor events, maintenance prescriptions, and some elective procedure) taken care of and then have a heart attack and run up a $280k tab, and expect the system to stay solvent. Healthcare is one area where manpower is necessary to get things done, and people who are competent and reliable cost a _lot_ of money to hire, train, and retain. Most people would be surprised to find that the job which pays them $25/hr requires billing them out at $75/hr to be worth while for the company (you know, that 2-8% profit margin). And hiring reliable people to work on the most basic parts of your health costs quite a bit more than $25/hr most places.

The more government regulates to turn insurance in to a welfare program, by refusing to let insurance companies charge according to known risk, the more incentive low risk people have to buy their insurance offshore, evading government regulation.

This is beginning to happen already. Government refuses to let insurance companies exclude alcoholism because they don't want a lot of uninsured drunks clogging up the system. This hurts T-totalers like Mormons that could otherwise get a lower rate. Another exampl

Except that (given the current model of insurance and health care as a commodity rather than a human right) when you purchase and insurance policy they have every right as a business interested in making money to say: "Do you have any pre-existing medical condition or genetic predisposition to any significant medical illness?" If you say no when the answer is truly yes, you are violating your end of the contract. If that can be proved in the future by subpoenaing your private health care records or if you actually do something like the woman in TFA that reveals your genetic status in your health care records, they can cancel your policy, since you lied when entering the contract for health insurance.

And since this is a business contract, your medical privacy is meaningless since the insurer can also (as a condition of selling you the policy) require you to allow access to all medical records and tests. Of course they likely won't do that unless you actually become sick and they have to pay money for your care. If they do, they hire people to scour your medical record for one slip up (like you may not have revealed you had a cold in December 1987 for which you were prescribed robitussin with codeine) as a means to void your policy.

Events like the recent ruling in favor of a woman whose insurance was canceled while she was undergoing treatment for breast cancer (because she had failed to reveal a history of a heart ailment and she mis-estimated her weight) are unusual - but only in that the arbitration judge ruled in her favor. Most of the time, arbitration (which you must agree to when buying any private insurance - they all require it) goes in favor of the side with the best attorneys to back them. No surprise that the insurers love arbitration. However this case was so egregious that even the arbitration judge was shocked - for example by the fact that healthnet maintained there was no real harm to the woman from dropping her (since after a couple of months she was able to get care in a state program) or the fact that company documents revealed that employees of healthnet actually got bonuses based on the number of policies the were able to cancel for patients on whom the company was losing money (i.e. sick ones.) http://www.latimes.com/features/health/la-fi-insure23feb23,1,2680255.story [latimes.com]

Except that (given the current model of insurance and health care as a commodity rather than a human right) when you purchase and insurance policy they have every right as a business interested in making money to say: "Do you have any pre-existing medical condition or genetic predisposition to any significant medical illness?" If you say no when the answer is truly yes, you are violating your end of the contract.

- The simple solution would be to outlaw such questions from being raised

- The more intelligent solution is to outlaw discrimination based on pre-existing medical conditions (thus destroying the business model of the insurance industry as it exists now in the US, which wouldn't be a bad thing). The point of the medical industry is to cure people. The point of the medical insurance industry is to make the most money possible. They are contradictory goals for which only legislation can facilitate a more rational change.

And a point from the article:

A bill that would ban genetic discrimination by insurers and employers -- and presumably make people feel safer about taking care of their health -- is stalled in the Senate.

I will tell you that if insurers have this information then they will take steps to discriminate and obfuscate this discrimination as best they can. Like any other multi-billion dollar industry, these people are not fools or philanthropists; they will use creative accountants (think Enron), statisticians (think Ford Pinto), lawyers (just think, no explanation required), lobbyists, MBAs, etc to get what they want and minimize any adverse effects of their image.

The more intelligent solution is to outlaw discrimination based on pre-existing medical conditions (thus destroying the business model of the insurance industry as it exists now in the US, which wouldn't be a bad thing). The point of the medical industry is to cure people. The point of the medical insurance industry is to make the most money possible. They are contradictory goals for which only legislation can facilitate a more rational change.

Except that its the 'for profit' part that is the problem, whether its health insurance or health care delivery. For profit providers of health care also have the same problem (like the famously substandard care that is delivered at nursing homes owned by large for profit corporations.) And similarly, non-profit insurers (cough-Kaiser-cough) in the US are way not as evil as for profit ones. I have had several patients (in the sliding scale clinic where I volunteer 2 days a week) who sought individual policies who had pre-existing conditions - while none was offered any plan by BCBS, Aetna, Health Net, et al, Kaiser covered them all - albeit after I had to send a buttload of tests on some of them and one with an exclusion for one type of care. Kaiser is also one of the few insurers who doesn't as policy drop individual members when they become ill. But then they spend most of the money they take in on care, and none goes to profit. If you have to pay out 25% of your money as profits and administration, you gotta pinch pennies somewhere. Pruning the sick and expensive folks is easy and very successful!

Its not rocket science: You can do health care for people or for profit. Not both simultaneously.

That is pretty much implicit as to what I was saying. I think universal health care like we have here in Canada would be the most fair and utilitarian solution. The main disadvantage is that the rich would not be as advantaged, like having faster access to non-emergency or non life-threatening care. The free market people can bitch all they want, but I know (and yep it's anecdotal) from personal experience (through many friends and relatives) that if people need (for example) cancer treatment, or therapy for a stroke; they will get it pronto and it won't be in some cheap third world style clinic. No it's not free; we pay for it through our taxes. But since everybody pays for it and there are no sales people or middlemen making money, it's overall cost is cheaper than it is in the US. It may not have the polish and shine that a CEO wanting health care would want, but it works. And yes universal health care is not directly on-topic so I was avoiding stating it explicitly.

Just to finish addressing your point, most of which was already well covered by the previous poster:Newsflash, free shitty health care is available right now in the united states it's called the emergency room and just don't pay the bill.

You do realise that you already pay for that out of your state taxes right? For the many millions of uninsured Americans (and illegal immigrants) without a primary physician or any form of preventative medicine, when a condition gets so bad that they have to turn up to the

Under the condition that the subject of the test must not be coerced or required to take the test, I agree. That would include any form of explicit or implicit requirement, e.g. for employment the employer would not be allowed to require or encourage DNA tests (by preferring candidates who subject themselves to the test).

There are many countries with public health insurance, and none of the have any such requirements. There's obviously no use to them if you can't deny coverage anyway.
As to your story of healthcare being denied to some people: even if it's true (which it is not in my "socialist" country), it doesn't take away your option to pay for those procedures yourself. That shouldn't happen too often and even if it does, you're in the same position as you ALWAYS are in the US: ridiculously expensive healthcare.

Don't be ridiculous. Here in the UK, as in Canada and a lot of other developed nations, technological advances such as this are hugely advancing prevention of inherited diseases. My ex, for example, discovered she had a gene which made her prone to a certain type of cancer, so the NHS (national health service) put her on regular screenings for it.

Free health care doesn't have to mean lower standards. All the bull in the USA slating universal healthcare is coming from.... you got it, the medical insurance i

But the NHS is not the only way to access health care in Britain, any more than the various provincial medicare programmes are the only way to access health care in Canada. If you are rich in Britain you can get faster care, just as in the US. Even in Canada we have an extremely steeply stepped two-tier system, in which the second tier is known as the United States, where the ultra-rich like Liberal politician Belinda Stronach go to get the treatment they deny others in Canada.In the US you also have a mu

Do you happen to be a Fox News pundit?Step back a minute and use your brain. Under what health care system would mandatory genetic testing be more likely to be misused? A system where insurance premiums and profits are maximized by reducing or refusing care; or a system where everyone pays, everyone participates, and everyone benefits?

In the current system, mandatory DNA testing would be used to refuse coverage or care - to maximize profits and weed out costly/sickly individuals.

DNA testing will just be another way to make it more "fair" and "rational.'

That is, profitable.

I see some people from Europe and Canada posting here about how wonderful their respective medical systems are, and how America should move towards a socialized approach for our health care.

Might as well try to institute such a system in Mexico, or any other nation with thoroughly corrupt government and private sectors (like the U.S.) I mean, hell, we've been throwing money at the education system for years (sixty percent of my property tax dollars go to "education") and for all that we're near the bottom of the education heap. Why does anyone believe that throwing vast sums of Federal money at the medical system, thereby subjecting all of us to even more government scrutiny, will have a positive outcome? When will we understand that these people can't be trusted with the power they already have? Yes, I know that countries like Germany have a fine socialized medical system... but that means nothing here. Our bureacracies are very different: their's works very well and has a much higher degree of trustworthiness than ours ever will.

Besides, people forget that we've already had socialized medicine in the U.S. for decades: it's called Medicare. Do want more of that? Yes, it's only for older people, or those of any age who have specific conditions (such as total renal failure) but it can hardly be pointed to as a successful operation from a cost-benefit perspective. Any national health-care system as proposed by some of our Presidential candidates would, in effect, expand the Medicare tax base to theoretically include everyone. Given the fraud and malfeasance and gross inefficiency of the current Medicare system, I simply don't believe that our government (or our health care providers) can be trusted with even more power than they already have. The way they handled Medicare has conclusively demonstrated that they are incapable of acting honestly and in good faith when it comes to health care.

I'm not saying they'd just make Medicare bigger: they'd probably establish an entirely new bureaucratic organization to handle a national medical system. What I am saying is that any such organization will be just as efficient and trustworthy as the DHS, the TSA or FEMA. It can't help but be anything else, given how our government works today. Furthermore, given the propensity for certain three-letter agencies to ignore their charters and lie to Congress, you can bet that socialized medicine would be a privacy disaster.

We'd probably be better off getting the food lobbies out of Congress and spending some serious money on public education, to teach people how to eat. Hell, if we just got a significant number of people to lay off the fast food it would cut the number of new diabetes and cancer cases. In the long run, if we became a healthier nation overall, we'd have less dependence upon advanced medical services.

Just make it a single payer system. That would be the federal government's sole responsibility, not deciding on treatment or deciding anything else. (They already foot the bill for the military, let 'em foot the bill for health care and for the same reasons.)

It would eliminate most of the shenanigans and multiple price lists that are currently a major headache with spiraling health care costs.

They already foot the bill for the military, let 'em foot the bill for health care and for the same reasons.

Do you have any idea how corrupt and wasteful the military/industrial complex is? It's too bad my father isn't still around: he'd enlighten you in great detail. The reality is the government does nothing efficiently. That's not always bad... I'm glad the DHS and TSA aren't very efficient at what they do. But when it comes to providing certain kinds of services you don't want the Feds directly supp

Of course, testing is only the first step. Expect to see those with expensive, insurable genetic conditions simply denied care, much as those over 70 are denied health care for many ailments in the UK because it's not "cost effective."

ITYM expensive, uninsurable genetic conditions - since there's no way in hell anyone will insure them for an affordable price. (Also, the UK thing is, I think, an incredible exaggeration - there are issues with the treatment of the elderly, but they aren't flat out refused

Actually I think the opposite will happen with nationalized healthcare. Since a nationalized system exists to provide care for constituents, and not profit to shareholders, I believe that taking insurance companies out of the loop will fix this problem.
The US is the ONLY major industrialized nation to not have nationalized healthcare. And the quality of our care is abysmal. Your scaremongering about "socialized" medicine is hysterical, unfounded nonsense.

All that needs to be done is legislation that requires any insurance company to accept anyone, and that the rates for individuals may not differ more than by a factor of 3. More legislation to help drive the cost down: Set a max to the amount of money in case a person dies because of a medical mistake at $100,000 and for invalidity at $500,000. Of course, expect to lose a couple of more quarters for ambulance chasers turned into beggars.

First, while I am a doctor and hate med-mal attorneys, they are not what is bankrupting the health care system. They add some, but systematic uninsurance and $0.25 on the dollar profit is what's crippling it.

But let me expand on your idea. Say we require insurers to just charge a set community rate, and not be allowed to decline care because of a pre-existing condition. Of course that would drive the cost of insurance up because a lot of young and healthy folks (who pay more in that they get) would opt

Its not just/. It cuts across the entire US population. And its for several reasons.

First, with more and more people who are uninsured or underinsured, the experience of finding oneself with a serious illness and no way to get help without bankrupting yourself and your family is becoming more common. This experience is also entering into the middle class (and even upper middle class) ethos because its not just a poor person's problem anymore.

Second, any idiot with a modicum of intelligence can see that the US health care system is failing the US population. Even those who are insured cannot be guaranteed care when they need it. The US is undergoing an emergency care and on call crisis due to the problems created by uninsurance. If you are a specialist and agree to be on call for a hospital, or you are a hospital who has an ER, or if you are an ER physician on duty in those hospitals, you are bound by the EMTALA law which says you have to provide care for all medical emergencies regardless of ability to pay. This unfunded mandate is pushing emergency care to the breaking point. From 1993 to 2003 in the US, 425 hospital EDs closed their doors; the number of ED visits rose by 26% during the same period (Institute of Medicine, 2006). Moreover try to find that on call neurosurgeon you need to drain your epidural hematoma or the hand specialist to reattach your finger in under 4 hours. Specialists are now refusing to take call because it makes them vulnerable to provide uncompensated care. So while years ago, it was only the poor who suffered, now even the insured are suffering because ERs are overcrowded and specialists are just unavailable. (See what's going on in LA's now as its emergency system implodes if you would like an example.)

Third, (and this is the only thing that has kept me from leaving the US to practice in Canada), I genuinely think the American people are good and want a system that provides people health care just like we provide every child an education and other services like EMS, fire, and police. When bad things happen to others, I think Americans really do want to help. I saw that when I was a chief resident in the ER at Brooklyn's largest trauma center on Sept 11, 2001. We saw it in the actions of individuals and organizations to help NOLA after Katrina when our government stood by with its hand up its ass. Most of us, at heart, are not hateful neocon hawks. However, the hateful neocon hawks have pretty mighty propoganda machines and they were able to fool a lot of people a lot of the time. But eventually we do come around. Witness the phenomena of Evangelical Christians who won't vote Republican because while they don't support abortion rights, or my right to marry my partner, they think that the US's inaction in Darfur, the war in Iraq, the fact that Americans are dying as I type this from preventable diseases, the fact that poor children are abandoned in drug and gun infested warehouses that used to be schools are far worse tragedies than the fact that I have buttsecks with the man I call my husband.

And I would damn rather work in an organization with one of those folks or have one as my neighbor than you. Because she and I would both be Americans who love our country and understand that diversity of beliefs are OK, but that first and foremost we have to ensure that there is social justice, that every child has an education, that every person has health care when they need it, and that our military and our political capital is spent on real problems like resolving the tragedy in Darfur and creating freedom in China rather than creating a profit for Haliburton.